Dental pain
A looming shortage of dentists means lack of access, care
throughout the state.
By Jon Bell
Every year, about 75 new dentists graduate from the Oregon
Health & Science University School of Dentistry, 50 to 60
of whom go on to practice in Oregon.
Every year, the state’s only dental school has 75
openings for new students. And every year for the past few
years, the school has had more than 1,000 prospective students
apply for those 75 openings.
Those numbers would seem to indicate not only that there are
plenty of aspiring dentists out there, but also that there is
an ample supply of new dentists joining the Oregon ranks every
year.
The reality, however, is that dentistry in Oregon may be
facing a workforce shortage similar to that of many other
health-care professions. But even more pressing than the fact
that the number of new dentists isn’t quite keeping pace
with population growth is that rural access issues, a graying
workforce, educational debt and an unequal distribution of care
are all taking a bite out of the future stability of dentistry
in Oregon.
Oregon, like a lot of other Western states, has a huge
distribution problem, besides a growth issue, says Jack
Clinton, dean of the OHSU School of Dentistry.
“There’s a numbers problem and a distribution
problem, so getting dental care to the Oregon population is a
very intense challenge.”
According to the Oregon Dental Association, there are about
2,500 dentists licensed in the state, some of whom are retired
or practice outside of Oregon. Both Clinton and William Zebb,
president of the ODA, cite studies from the American Dental
Association that point to a potential future workforce shortage
on the national level.
“Where we sit right now, they’re projecting that
there might be a dip [in dental workers] around 2010,”
says Zepp.
PART OF WHAT COULD CAUSE THE SHORTAGE in Oregon is strong
population growth. Oregon was one of the 10
fastest-growing states in 2005, and population is expected to
grow by 1.4% annually over the next three years.
Such steady growth could make it hard for dentistry to
maintain a sufficient dentist-to-patient ratio, although
variables, from regional demographics to increased dentist
productivity, can account for and offset imbalances.
In Oregon in 2004, there were about 55 dentists per 100,000
people, down from 62 per 100,000 four years earlier, according
to a recent report from the state Department of Human Services
(DHS).
Another trend putting the squeeze on Oregon dentistry —
and also surfacing in professions from truck driving and
farming to nursing— is that of an aging
workforce.
In 2002, the Oregon Health Workforce Project found that the
average age of dentists in Oregon was 49; in addition, 61% of
active dentists were over the age of 45 and 31% were 55 or
older.
That gradual graying mirrors the population as a whole, so not
only are dentists getting older, but as the baby boomers are
aging, they’re requiring more oral care.
“The graying of our population — it’s
exactly the same in the dental profession and it’s
equally the same in Oregon,” says Clinton, who’s
worked at the OHSU School of Dentistry since 1964. “A
great number of our dental providers have retired or will
soon.”
Exacerbating the dental outlook even
further is the issue of care distribution, a particular ache in
a state like Oregon with its urban and rural extremes.
According to the Workforce Project, more than 80% of the
state’s dentists practice in urban or mixed urban/rural
areas; 18% practice in rural areas. “We probably have
plenty of dental providers in the Portland metro area,”
Clinton says, “but you go out to counties such as
Gilliam, Lake and Klamath, and they’re very
underserved.”
Shanie Mason, Oral Health Program Manager for the DHS, says
all but nine of Oregon’s counties contain designated
shortage areas for dental health professionals. Such
designations are based on the following factors: geography
— for example, the eastern half of Baker County; migrant
farm workers, such as in Umatilla County; low income, as in
Coos County; and homelessness, as in Multnomah County.
That such a cross-section of counties contains shortage areas
reveals the paucity of oral care manifests itself in different
ways, from geographic isolation to a lack of resources.
“Rural residents and urban residents have the same need
in terms of oral health,” Mason says. “Where the
differences come in is in the challenges meeting those
needs.”
IT IS NEVERTHELESS IN THE RURAL AREAS of the state where the
shortage — which also encompasses dental hygienists
— is most acute. Far fewer oral specialists, such as
endodontists and periodontists, practice in rural areas; of the
state’s 79 licensed pediatric dentists, just 27 practice
outside the Portland metro region.
Dentist Sean Benson has been practicing in Baker City for more
than four years now. He says many of his patients drive from
John Day or La Grande, a drive that for those used to the rural
way of life “isn’t viewed as a big hardship.”
An avid rock climber and skier who relishes Baker’s
small-town vibe, Benson says many young dentists fresh out of
school falsely believe that the key to financial success is to
practice in an urban area.
Burdened with educational debt — the average for dental
school graduates is in the neighborhood of $130,000
— and the prospect of spending up to $1 million on
an independent practice, many young dentists stick close to
urban cores, Benson says.
“I think you’ve got to dispel the notion that a
practice is more lucrative and more rewarding in the metro
areas,” he says, noting that his small-town location
provides him with a sizable patient pool.
OHSU has begun work on several initiatives to help get a
handle on the possible dental shortage and the distribution
issue in Oregon.
Long-term, the school of dentistry has plans for a new and
larger campus in Portland’s South Waterfront district. As
that’s still at least six years off, Clinton says in the
interim the school has launched a pilot program that may
eventually require all senior students to serve as a resident
for a few weeks in a rural setting.
“It’s less about dentistry and more about quality
of life,” he says. “I think it will be a very, very
powerful way of influencing the distribution of
care.”
The school may also institute a one-year residency for
graduates that emphasizes intense training in dental
specialties, thus better equipping dentists for work in
underserved areas.
The ODA, too, is working to address the overall issue. Brett
Hamilton, managing director of public and professional
education, says the association regularly lobbies to protect
OHSU’s budget. The ODA also has pushed for tax credits
and loan forgiveness to serve as incentives for dentists to
practice in rural, underserved areas.
But more than anything, the 1,500-member ODA pushes water
fluoridation as a way to help solve dental workforce and access
issues. Oregon ranks 48th among states for water
fluoridation.
ODA and others believe that the preventive benefits of
fluoridating community water sources can improve overall oral
health and help ease some of the pressure on Oregon’s
dentists.
“There’s such an obvious answer,” Hamilton
says. “Prevention. It’s not going to solve
everything, but it’s going to help.”
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